Why Teledentistry?

The COVID-19 pandemic has made it very clear that telemedicine is a necessary tool in most healthcare fields. Teledentistry in particular has been an effective means of connecting patients with oral health care providers while prioritizing patient and provider safety. However, beyond the scope of health care during a pandemic, teledentistry has invaluable benefits that will continue to improve equity and access in care, even post-COVID-19.

That’s why improving the legal framework around teledentistry is one of NCOHC’s top priorities in 2021.

Graphic displaying the differences between synchronous and asynchronous teledentistry

Why does policy change need to happen for teledentistry to be used?

Any dental provider anywhere in North Carolina can use teledentistry to some extent today. However, teledentistry is not well-defined in North Carolina’s Dental Practice Act—which makes sense, as remote care technologies are fairly recent innovations.

Fortunately, the North Carolina Division of Health Benefits (NC Medicaid) did enact temporary provisions allowing providers to bill for teledental services while the COVID-19 pandemic continues to require heightened safety precautions. Private payers in NC have also embraced teledentistry by incentivizing its use during COVID-19. NCOHC believes that these provisions should be made permanent.

Why do we need teledentistry post-COVID-19?

Teledentistry is an important means by which to increase access and equity in oral health care. There are counties in North Carolina without any practicing dentists. Expanding the use of teledentistry and permanently adopting appropriate payment models would allow many North Carolinians, especially in rural areas, to access care they might otherwise not receive.

There are several social determinants of health that affect a person’s ability to access reliable health care. Some of the biggest include lack of access to reliable transportation, the inability to take time off work and, for parents, difficulty finding someone to take care of their children while they are away.

Teledentistry can be used to help overcome some of these barriers. Obviously, dentists cannot fill a cavity remotely and a hygienist won’t be cleaning teeth remotely. Nevertheless, streamlining the process can significantly ease the burden on patients short on time, transportation, and more.

Take for example a patient who goes into the office for a routine exam and cleaning appointment and is found to have a cavity. Often, the filling is scheduled as a follow-up appointment. If basic screening is conducted remotely, the required two trips to the office, two periods of time off work, two babysitters, and so forth, could possibly be cut in half.

On the flip side, follow-up appointments to check in with patients who recently had work done can be conducted remotely, again reducing the burden on those seeking care.

For more information on teledentistry, visit our accompanying blog post, “Envisioning Teledentistry in North Carolina.”

So, what’s next?

Permanently adopting teledentistry payment models would reduce obstacles for dentists who want to offer remote care options and provide greater efficiency in care delivery.

Providers — especially those in safety-net clinics with thin profit margins — already frequently use teledentistry, often without reimbursement. Safety-net providers will continue to use teledentistry to provide patients with essential care, and it is important that payment systems support this innovation in care delivery through equitable payment schedules.

Stay tuned as NCOHC works during the 2021 legislative session to ensure teledentistry legislation is passed. Head over to NC4Change and help us take steps forward for positive change today.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!


2021 Legislative Perspective

Graphic with text, "2021 NC Legislative Perspective"

As we move forward into the new year, it is important to be aware of policy changes that may directly affect access and equity in oral health care for North Carolinians. We sat down virtually with Ben Popkin, The Foundation for Health Leadership & Innovation’s political strategist, to gain insight into what health care professionals, providers, and patients should be on the lookout for in 2021.

Health policy consultant Ben Popkin began his career as a staff attorney in the North Carolina General Assembly’s Research Division. He has also worked in the legislature’s bill drafting division. Popkin has experience in the Medicaid transformation space, and has helped the North Carolina Oral Health Collaborative achieve great strides through his lobbying and strategic planning advice for public health groups.

Popkin will assist NCOHC in several key areas of focus during the coming year. With the COVID-19 pandemic still impacting daily life, creating a more defined structure for telehealth, specifically teledentistry, is particularly important among the oral health community.

Teledentistry and Dental Hygienist Regulations

Teledentistry is not currently prohibited, but in North Carolina there are a lack of guardrails for those who use it. Popkin says that it is important that there be “a safer and more defined structure that includes standards of the practice, such as patient protection and informed consent.” It is critical to move toward legislative changes that support the permanent adoption of teledentistry models.

Read more about teledentistry in NOCHC’s policy brief

There are several North Carolina counties that do not have any practicing dentists. Lack of oral health care is not aided by the fact that North Carolina is particularly restrictive when it comes to the services dental hygienists are able to provide. Popkin notes that allowing hygienists to provide more services — like administration of local anesthesia — would increase productivity and efficiency in dental care.

“We want to reduce obstacles to dental hygienists and even to dentists who want to provide care to underserved areas,” Popkin says. Along with moving teledentistry forward, placing a priority on giving dental hygienists an increased ability to do the job they are qualified and trained for, would lead to meaningful victories for providers and patients alike.

Regulatory vs Legislative Policy Changes

NCOHC achieved several policy victories in the past year, most notably the 16W rule change, which allowed dental hygienists to provide preventive care services to individuals without having to have first received a prior examination by a dentist.

This was a regulatory policy change, as opposed to a legislative policy change.

“The typical structure is to have the required details for an initiative laid out in statute. Once the legislature has enacted law, a respective agency would adopt the rules. After the underlying framework is provided in statute, then the rules would provide the specific details for how to implement the initiative,” explains Popkin.

In other words, a legislative policy change involves the North Carolina General Assembly support and enactment on a bill, whereas a regulatory change involves a board, such as the North Carolina State Board of Dental Examiners (NCSBDE) approving an amendment to rules they have authority over.

Changing policy through the regulatory process involves making a specific rule proposal, which would first be either approved or denied by the rulemaking body in question. If approved, the rule would then go through the Rules Review Commission, which either approves or denies the rule after checking for precise legal authority.

“When it comes to teledentistry, our focus is on the legislative approach to enact statutes because of the detail needed to guide the rules,” Popkin says.

Popkin is optimistic about a teledentistry bill being approved in 2021. When asked about the specifics needed to push a bill forward, he mentioned the importance of issue experts like Dr. Zachary Brian, NCOHC’s program director, speaking directly with policymakers.

Events like NCOHC’s Oral Health Day helped to disseminate information to legislators and the general public about the importance of teledentistry. Collaborating with high-level universities, creating public awareness, and continuous contact with decisionmakers are crucial elements of successful policy change.

NC Government in the 2020 Election

In North Carolina’s 2020 elections, the outcome was fairly stable. The Republican party remains in control of the State Senate and House of Representatives. In the Executive Branch, Democratic Governor Roy Cooper was re-elected, meaning that the Health and Human Services Department staff also remains the same.

Popkin is hopeful that NCOHC’s goals will be treated in a non-partisan way.

“In North Carolina, we have a great health policy community…My goal is to bring consensus among parties and get a win for everybody.”

National Perspective: Future of the Affordable Care Act

At the federal level, there has been a very public shift in the Supreme Court. As far as the future of the Affordable Care Act, Popkin says, “It remains a very politicized topic. We will have to wait and see what happens.”

North Carolina was awarded nearly 90 million dollars to implement systems that would help provide people with healthcare. Popkin explains that there is yet to be a viable alternative proposal and, should it be repealed, many North Carolinians could be in danger of losing their insurance coverage.

“When politics infiltrates a subject, it is difficult to have a nonpartisan discussion,” Popkin said.

However, he is doubtful that the Affordable Care Act will completely disappear any time soon.

Get Involved

When asked how readers who are passionate about increasing access and equity in oral health can get involved, Popkin encourages people to reach out to their elected officials. “Email or call your legislators and let them know what’s important to you. It’s not uncommon for a member of the public to initiate an effort that can become law.”

You can now engage with the legislative process easier than ever. The General Assembly’s website allows you to follow chamber discussions, committee meetings, read up on actual drafts of bills, look up regulations, and find your legislators.

Want to get involved in building a more accessible, equitable oral health landscape in North Carolina? Become a North Carolinian for Change today! Our new platform will connect you with the most impactful opportunities to get engaged in efforts to change policy and build a future where all North Carolinians can get the care they deserve.


0-5: A New Parent’s Guide to Oral Health

A newborn’s growing teeth are crucial to their overall development as a child. Baby teeth are the foundation for a strong set of adult teeth because they act as placeholders for permanent teeth. Poor oral health when your child is young can often result in crooked teeth and more serious oral health complications.

For more on why baby teeth matter and how to protect them, visit this American Dental Association resource.

So, when should I start brushing my child’s teeth?

It is safe to clean your baby’s mouth shortly after birth. Using a clean, moist washcloth, wrapped around one finger, carefully massage the gums. This can be done after every feeding until their teeth start to appear at around six months.

After the first teeth start to appear, brushing with a soft bristled toothbrush can significantly reduce the risk of tooth decay. Be sure to regularly check inside your child’s mouth and under their lips for white or brown spots that may be indicative of cavities.

Figure displaying a smear of toothpaste for children under 3 and a pea sized amount for children and adults 3 and up

Brush with a small amount of fluoride toothpaste (about the size of a grain of rice) until your child is three years old. After the age of three, a pea-sized amount of fluoride toothpaste can be used to brush their teeth. By this age most children will have all 20 primary teeth. Begin teaching them to spit to avoid swallowing the toothpaste.

Allowing your child to pick their own toothbrush and toothpaste can encourage regular brushing. Just be sure to check for the American Dental Association (ADA) seal of approval.

A consistent routine is the single most important thing you can do to ensure your child has a healthy mouth; but how teeth are brushed can also make an impact. Try to use small, circular motions as well as you can — it can be tough, especially when you begin teaching your child to brush their own teeth.

Brushing should be supervised twice a day until the age of six, when children are typically able to do it alone. Clean the inner, outer, and chewing surfaces for a total of at least two minutes every time.

Check out these handy guides for parents and children about developing good oral health habits. You can even print one for your children and hang it in the bathroom.

Graphic for children with five steps to a good brushing routine

Click the image to download a printable version or to see an additional guide for parents

What is teething?

Did you know babies are already born with all their tooth buds?

Teething is when your baby’s teeth begin to push through the gums. This typically occurs between months four and seven. However, it is important to remember every child is different and for some, this can even occur at 12 months. Slower rates of growth are not necessarily a means for concern.

The two bottom front teeth are often the first to appear, followed by the four top front teeth. The last to erupt are generally the molars and eyeteeth, which are located in the upper jaw.

For some children, teething can be a frustrating process that may cause irritability. For others, it may appear painless. You will likely notice more frequent drooling and the desire to chew on different objects. This is perfectly normal and is a form of coping with the new feeling.

To relieve some of the symptoms of discomfort, give your baby safe toys such as a rubber teething ring with no liquid inside. A wet washcloth that has been frozen for about 15 minutes may also be helpful. Continually clean around your baby’s mouth to prevent rashes if there is excessive drooling.

When should I take my child to the dentist?

It is possible for cavities to appear in the mouth as soon as the first teeth erupt. Therefore, it is important to be proactive with oral care. One of the best ways to do this is to schedule a dentist appointment.

According to the American Dental Association, a child’s first dental exam should be scheduled no later than the first birthday or after the first tooth erupts, typically around month six. The American Academy of Pediatric Dentistry also recommends regular visits every six months after this.

During these visits, the dentist will clean the teeth and can apply a fluoride solution to fight cavities. They will also check on teeth development and give advice on how to maintain proper hygiene.

For more information about early childhood preventive solutions like fluoride varnish and dental sealants, click here to see last week’s blog post.

The American Academy of Pediatrics has also developed a schedule of well-child visits to reinforce the overall well-being of developing children. This entails a recommended visit within the first week of birth, and then once a month for the first two months. After that, the child should be seen once every two months until the child is 18 months old. It is recommended the child be seen twice a year at age two, and then once a year until they are 21 years old.

If you notice anything concerning about your child’s teeth, or hear your child complain about pain, you should also make an appointment with the dentist.

For more information about well-child visit schedules, click here.

Caring for your child’s teeth at home

A healthy diet is important for a developing child and can have a direct impact on their teeth. Too much sugar can eat away at the enamel that covers the outer layer of the teeth, leaving them more vulnerable to plaque and bacteria.

Try to limit your child’s sugar consumption to avoid the risk of tooth decay and other health complications.

If you do not have access to fluoridated tap water at home, using a fluoride toothpaste is especially important. Fluoride is safe for young children and is one of the most effective forms of preventive care. The dentist may also prescribe chewable tablets or fluoride drops for your child if necessary; another great reason to schedule regular dental appointments!

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!


Teaching Equity in Dentistry

MLK Jr Quote: "Of all the forms of inequality, injustice in health is the most shocking and the most inhumane because it often results in physical death"

When creating equitable health care systems, especially at a statewide level, policy plays an important role in driving sustainable, system-wide change. Before policy can be implemented, however, advocates must start by changing peoples’ mindsets.

We recently sat down (virtually) with Dr. Sylvia A. Frazier-Bowers to discuss her role as Assistant Dean of Inclusive Excellence and Equity Initiatives at the University of North Carolina Adams School of Dentistry. Dr. Frazier-Bowers’ goal entering her position was to be an advocate working to change the mindsets of stakeholders when it comes to equity. Her goal was to teach people to be conscious of inclusivity and equity, which is now being incorporated into the Adams School of Dentistry’s curriculum.

Headshot of Dr. Sylvia A. Frazier Bowers

“Equity refers to fairness,” said Dr. Frazier-Bowers, speaking about the importance of the word equity in health care and how it differs from the word “equality.”

While equality means treating everyone the same, or providing the same inputs into a system, equity means providing everyone with the resources and assistance they need to achieve successful outcomes. Equal treatment is important, but in a world where we are all different, with different experiences, abilities, disabilities, and resources available for our use, we inherently need different things in order to be successful. When all stakeholders have the opportunity to be successful, everyone benefits.

It is no secret that historically, people in the United States have been discriminated against because of race. While we have undoubtably made huge strides toward a more just society, the impact of historical injustice lives on, and there are still structures and individuals today who perpetuate inequity along racial lines.

For a non-oral health example of system-level equity with important ties to the dental world, see NCOHC’s interview with Duke Wold Food Policy Center Director of Strategic Initiatives Jen Zuckerman.

Dr. Frazier-Bowers explained that if two groups are given the same amount of a given resource, one may still be at a disadvantage if they started out further behind. When it comes to health care, equity may actually mean giving some people more help just to overcome existing disparities.

The Adams School of Dentistry curriculum is currently being revised, and the Office of Inclusive Excellence and Equity Initiatives is working to incorporate equity education into the dental school’s coursework.

“Instead of having an insular experience of, ‘Okay everyone, we’re now going to learn about equity and justice,'” said Dr. Frazier-Bowers, “It’s going to be integrated more seamlessly throughout the four-year curriculum.”

Working with experts in equity and justice education, the school designed the Advocate, Clinician, and Thinker (ACT) framework to integrate knowledge of racial equity throughout the four years of schooling, rather than as a small section.

Text of a 2018 Adams School resolution declaring UNC Dentists as "Activists, Clinicians, and Thinkers"

To further incorporate equity education into the student experience, the Adams School of Dentistry was the first to coin an Inclusive Excellence Week, offering weeklong experiences to promote equity. Working with a community of scholars from different disciplines, the Adams School of Dentistry is able to communicate regularly with content experts who can influence new ideas and portray the interconnectedness of their work. The Adams School of Dentistry’s Inclusive Excellence Week influenced dental schools at other universities to do the same.

According to Dr. Frazier-Bowers, when it comes to equity and inclusion, “Mindset is the key.”

“When I say the mindset, this refers to every time you engage in any activity,” said Dr. Frazier-Bowers. “Whether its teaching, seeing patients, being a student, or being a classmate even—think about it from a lens that considers inclusivity and equity.”

When asked about the most prevalent social injustices in dentistry, Dr. Frazier-Bowers explained how the fact that not everyone has access to reliable care is an issue. Unlike a second home or expensive car, “education and health care should not be considered luxuries,” she said.

For that reason, the Adams School of Dentistry is currently working on self-assessment and accountability measures where people can have an opportunity to reflect and search for improvement in the pursuit of equity.

“People must be willing to open their minds to truth and history,” said Dr. Frazier-Bowers.

Many oral health professionals already advocate for change and understand what needs to be done to create a lasting impact. For those who don’t, there are always ways to get involved, but you have to be willing to put in the work. The DOCSpeaks program was created by Frazier-Bowers to bridge the “knowing-doing” gap for well-meaning professionals.

In-depth blurb about the creation of DOCSpeaks

According to Dr. Frazier-Bowers, it all starts with education and an open mindset. The UNC DOCSpeaks sessions are a resource that can serve as a good starting point, and they will soon be open to the public. Outside of the education system, any community with the right leaders and the right mindset can be a catalyst for racial equity.

Want to get involved and elevate your voice? From diversity and inclusion in health care to the rising cost of health care, NC4Change is a platform for a diverse, inclusive group of oral health practitioners, public health professionals, community members, and other stakeholders who share a common goal: increasing equity and access in oral health care.

Head over to the brand new NC4Change page today and sign up for a focus group, give us feedback on our policy brief, and more!


10 Things You Should Know About Your Teeth

1. Brushing Your Tongue Can Help Bad Breath

The tongue may actually hold more bacteria than your teeth. With its many crevices, your tongue does a great job of trapping bacteria and can cause your entire mouth to smell bad. Similarly, the roof of your mouth can store bacteria, so make sure you brush them both. During the COVID-19 pandemic, “mask breath” can be a serious inconvenience. So, make sure you’re taking the necessary steps to maintain proper oral hygiene!

For more tips and tricks, download this helpful guide.

2. Keep a Routine

No matter what your habits may be, maintaining a dental routine is what really matters. While elaborate toothbrushes and other oral health tools each have their own function and benefits, they will not work without consistency. Similarly, a standard, run-of-the-mill toothbrush, if used for two minutes twice a day, can keep your mouth clean and healthy.

No matter the toothbrush or toothpaste you use, keeping up with a morning and evening routine for oral hygiene, along with healthy eating habits, are the most important steps to keeping your teeth happy and healthy.

3. Start Young

If you have children, the best time to visit a dentist is no later than their first birthday, or after their first tooth erupts. Taking preventive action early can help ensure that your children’s teeth stay healthy and strong as they grow, without major dental complications. Be sure to schedule regular dental examinations once every six months.

For more information on what to expect during your child’s dental appointments, visit this helpful page from the Mayo Clinic.

4. Oral Health Isn’t Just a Mouth Problem

Poor oral health disproportionately affects low-income families and people of color. Unfortunately, studies have shown that it is harder for people with underdeveloped hygiene or missing teeth to secure employment. Increasing education, access, and equity in oral health care can help mend some of these societal concerns.

5. Dental Anxiety

Fear and anxiety surrounding dental treatment is very common. As medical professionals begin to bridge the gap between health care services, therapists are able to work with patients to screen for common conditions like this. They can then implement breathing and relaxation techniques to provide a more comfortable visit. If you are not asked, but suffer from dental anxiety, tell your dentist and dental hygienist.

Anxious about the dentist? Try taking a stress ball with you to your next appointment. During your visit, implement mindfulness strategies, such as slowing and counting your breaths.

For more ways you can learn to cope with dental anxiety, visit

6. Be Wary of Acidic and Sugary Drinks

Fun fact: enamel is the hardest substance in the human body, but it isn’t invulnerable!

Too many acidic or sugary drinks may be harming your teeth. Some beverages have higher levels of acidity than others. These drinks can eat away at the enamel that covers the outer layer of your teeth, leaving them more vulnerable to plaque and bacteria.

Too much sugar can also lead to tooth decay, and soda is one of the easiest ways to consume large amounts. Try to limit your weekly number of sugary and acidic drinks to protect your enamel.

For more on how you can prevent tooth erosion, visit

7. Vaping and Cigarettes Can Damage Your Teeth

No smoking sign

Did you know that smokers are twice as likely to develop gum disease? Not only does smoking affect your breath, it can stain your teeth and lead to more serious complications, such as oral cancer. Similarly, the nicotine in both cigarettes and e-cigarettes can interfere with blood circulation and damage gum tissue.

Learn more about smoking and periodontal disease at

8. Your Saliva is Important

Your saliva is not just for drooling. It helps naturally wash away debris from the food you’ve eaten and can defend against the acid in some of those sugary drinks. You can also thank your saliva for killing some of those germs that cause bad breath.

Without saliva, your mouth would be more vulnerable to tooth decay and gum disease. Be sure to drink water and stay hydrated to maintain sufficient saliva production.

Got dry mouth? Visit for more information on xerostomia (dry mouth).

9. You Can Brush Too Hard

Most toothpastes contain abrasive ingredients such as calcium carbonate that help rid your teeth of plaque and bacteria. Similarly, the bristles on your toothbrush do a good job of scraping away these harmful elements. However, brushing too hard can actually damage the enamel on your teeth, leaving them more vulnerable to tooth decay.

When brushing, use about as much pressure as you would when writing with a pencil on paper. Make sure to use a soft-bristled brush instead of a medium- or hard- bristled brush. Brush in small circles for two minutes and don’t forget to floss.

10. Don’t Ignore Your Dentist

Regular dental appointments are not just for children. The recommended timeline for teeth cleanings is twice a year or once every six months. Even with good habits, consistent dental cleanings and checkups are essential. Oral health professionals will screen for oral cancers and other diseases in your mouth that are not easily caught. So, be proactive and keep your teeth and mouth healthy and safe.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!


NCOHC’s Policy Brief: Payment Reform

The North Carolina Oral Health Collaborative (NCOHC) released its first policy brief earlier this year, outlining a broad array of policy changes that, if enacted, would improve access and equity in oral health care for all North Carolinians.

Read the full policy brief here

Improving payment models can have a considerable impact on the care people receive, increasing efficiency and improving health outcomes. Payment reform refers to health care models that use reimbursement from insurers to providers to promote greater value for patients, purchasers, payers, and providers.

This third and final deep dive into NCOHC’s policy brief will focus on the payment reform section, elaborating on changes that can be made to make oral health care more efficient and affordable.

Teledentistry and Parity of Payment

Teledentistry has proven to be an effective means of connecting patients with their providers, especially during the COVID-19 pandemic. While remote care has proven to be invaluable in ensuring patient and provider safety, it is also a useful tool to increase equity in care, even in a post-pandemic world.

Unfortunately, some insurance plans do not reimburse for teledental services similarly to how they pay for in-person care.

Providers, especially in safety-net settings with thin profit margins, already frequently use teledentistry, sometimes without reimbursement. Safety-net providers will continue to use teledentistry to provide patients with essential care, and it is important that payment systems support this innovation in care delivery through equitable payment schedules.

Data suggest that patients receive the same quality of care via teledentistry as they do in person. For this reason, NCOHC recommends parity of payment across insurers.

Silver Diamine Fluoride

During the pandemic, there has been an increased focus on preventive care that reduces the amount of close-contact dental visits. One valuable resource in the realm of non-aerosolizing cavity management is the use of Silver Diamine Fluoride (SDF).

Aerosolizing refers to anything that can convert material into a fine spray that can be suspended in the air. Some dental procedures run the risk of aerosolizing the COVID-19 virus, leading providers to look to other, non-aerosolizing options.

When applied directly to a cavity, SDF can have a significant impact on reducing future urgent or emergent dental needs. As an efficient and cost-effective tool that doesn’t risk aerosolizing anything in the mouth, SDF is an ideal treatment to use during the ongoing pandemic.

Prior to COVID-19, payment for SDF varied widely. While NC Medicaid covered SDF, reimbursement was limited for patients five years old and younger. In vulnerable populations, however, many children may not even see a dentist before that age.

While NCOHC commends NC Medicaid for lifting all age restrictions for SDF reimbursement in response to COVID-19, it is important that these payment policies continue post-pandemic.

NCOHC recommends that NC Medicaid reimburse SDF placement for patients of any age. This will allow for more equitable access to this evidence-based treatment for both vulnerable children and adults.

NCOHC also recommends that the private payer sector incentivize SDF as a viable treatment through enhanced reimbursement policies.

Interim Therapeutic Restoration

Other viable options for non-surgical treatment of dental caries include Interim Therapeutic Restorations (ITRs). ITRs are non-permanent restorations placed on teeth to prevent cavities from progressing. Even though they are temporary, ITRs are effective reducing the negative impacts of caries until more permanent treatments can be administered.

Keeping in mind that many children rely on school-based care, this method of addressing tooth decay is particularly important because it could be delivered by hygienists, often at a lower cost. ITRs can dramatically help offset emergent needs in the immediate future. However, in North Carolina, this would be contingent on revision of delegated duties for dental hygienists.

Although many private payers currently reimburse for ITRs, a payment analysis should be done to ensure that they are incentivized as effective treatments through adequate payment models. Post COVID-19, NCOHC encourages NC Medicaid to also reimburse for ITRs.

Value-Based Oral Health Care Payment

As oral health care shifts toward a more value-based approach, focused on improving patient outcomes and lowering costs, it is necessary to think holistically about both the quality of care being delivered and how the care is delivered.

Care coordination management, addressing appointment compliance, motivational interviewing, and patient education to improve oral health literacy are services that should be covered by public and private payer sources to enhance patient-centered care.

These can be useful tools in helping people navigate treatment plans, coordinate transportation, and generally feel more comfortable engaging in social service support. All of these efforts can impact successful delivery of quality oral health care and improvement of patient outcomes.

Fact sheet titled "flip the incentive structure" about value-based care

Patient-centered care also means a patient-centered approach to financing.

When it comes to oral health management, emphasis should be placed on prevention. For vulnerable populations, it is often unknown when patients will be able to return for care. Bundling payment for services such as comprehensive oral health evaluations, prophylaxis for adults and children, topical application of fluoride and varnish, and sealants would incentivize providers to cover necessary services in a single visit.

NCOHC also recommends bundling nutritional counseling, tobacco counseling, and oral hygiene instruction as adjunctive non-paid services.

Payment reform and public policy must work in conjunction with one another to achieve long-lasting results. More often, payment reform drives changes in public policy. This means that Medicaid and private payers play a particularly important role in facilitation innovation in public health. As we begin to find new measures of success in value-based care, implementing these necessary changes will help improve peoples’ health and transform the oral health landscape.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!


Preventive Care During a Pandemic

The importance of preventive oral health care is often underestimated. There are many basic habits that can be implemented daily to reduce the risk of decay and other serious dental issues. During COVID-19, when there are more challenges to being seen by healthcare specialists, preventive care is critical.

Consistent dental exams are necessary during childhood; this is the time when issues are most treatable, and hygiene education can be implemented for long-term oral and overall health.

According to the American Dental Association, a child’s first dental exam should be scheduled no later than the first birthday or after the first tooth erupts. The American Academy of Pediatric Dentistry also recommends regular visits every six months after this.

The American Academy of Pediatrics has also developed a schedule of well-child visits to reinforce the overall well-being of developing children. This entails a recommended visit within the first week of birth, and then once a month for the first two months. After that, the child should be seen once every two months until the child is 18 months old. It is recommended the child be seen twice a year at age two, and then once a year until they are 21 years old.

Oral health education can have a significant impact on overall well-being. A common source of dental issues includes improper drinking and eating habits. If education is implemented at a young age to combat some of these dangerous patterns, future health concerns such as diabetes and obesity can be avoided. Other health risks associated with smoking and chewing tobacco can also be discussed during counseling in dental exams as children get older.

The pandemic has posed challenges to many, if not all, healthcare fields. COVID-19 has made it more difficult for patients to receive oral health care in a dentist’s office. Early guidelines from the World Health Organization advised people to delay their visits for non-essential oral health care like preventive care. This was a safety concern because dentists and dental hygienists work in close contact with their patients, and have a higher chance of spreading and contracting the virus. However, this has negative implications for peoples’ oral health.

The American Dental Association has emphasized the need for consistent dental care with safety precautions in place. During this pandemic, that means more PPE and sanitization. It is recommended that certain instruments which spray large amounts of water not be used. Dental hygienists and dentists are not able to see as many patients, due to increased time requirements between patients in accordance with surface sanitization protocols. Additionally, -travel and symptom questionnaires patients complete can also result in appointment postponements.

So, is it safe to go to the dentist now?

Many dental offices are open for routine care again, with significant safety measures in place. If you have any concerns about safety before your visit, give your dentist’s office a call and ask them a few questions, such as:


  1. What are your current COVID-19 protocols? doing to make sure that patients and providers are not spreading COVID-19?
  2. What kind of screening measures can I expect when I come in for my visit?
  3. How are you dealing with aerosolizing procedures? (This refers to the tools mentioned above that spray large amounts of water, a potential risk of “aerosolizing” the virus if it were present.)

What about mask breath? Can I do anything at home?

Due to prolonged periods of mask usage during the pandemic, many are becoming increasingly concerned about their own oral health.

Halitosis, a technical term for bad breath, is a preventable condition. One way to reduce “mask breath” is to brush your teeth at least twice a day, paying close attention to the tongue, which can hold large amounts of bacteria. Using fluoride toothpaste, fluoride mouthwash, and consistent flossing are also ways to prevent halitosis.

Do you have kids at home? Download this helpful guide and hang it in their bathroom to help keep their teeth healthy and happy!

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!


Mental Health Care in a Dental Clinic?

Mental Health and Oral Health services have traditionally been thought of as separate entities. To better provide efficient, affordable care, Greene County Health Care (GCHC) is bridging the gap, integrating medical, dental, and behavioral health services for its patients.

As a Federally Qualified Health Center (FQHC), GCHC serves patients across Greene, Pitt, and Pamlico counties in North Carolina. Their focus resides in increasing access to high-quality care for the underserved, uninsured, and underinsured.

Cori Davis, a MedFT at GCHC, went into detail about her role in connecting oral and mental health.

In the time between when a patient fills out their paperwork and is seen by a dental hygienist or assistant, Davis performs behavioral health screenings and interventions. This involves sitting down with a patient to evaluate their overall mental health.



She screens for common mental health concerns such as anxiety and depression. Davis also assesses dental pain and pain management, eating and sleeping patterns, as well as social and basic needs.

Though her brief interventions on managing chronic conditions and mental health issues can go a long way, Davis often makes referrals to other GCHC therapists, if needed.

“We have a lot of great therapists here that can devote more time to a long-term case,” Davis stated.

Additionally, Davis makes referrals to GCHC’s medical clinic for patients who need medical care.

Working closely with a social worker, therapists at GCHC can work through common issues like transportation and medication affordability. Ride-sharing services and other programs to help patients access the care they need are often covered by Medicare or Medicaid.

We asked Davis if she thought her work had a genuine impact on the overall health of the patients she met with, to which she responded, “Definitely, yes.” She explained that before patients even leave the room, they are given handouts and techniques so they may leave with tangible and practicable information.

Afterwards, there is more to be done.

“Connecting them to a healthcare system that can be with them and work with them long-term is really valuable so they have all of their services they need in one building.” Davis continued, “That really helps with continuity of care and making sure they can have sustained healthcare.”



One example of how these health screenings are linked to the oral health practice is when a patient suffers from dental anxiety. Evaluating this condition allows for the therapist to work through breathing exercises and relaxation techniques. This information is then communicated to the dental assistant or dentist so that they may implement these practices throughout the appointment.

“We’re really filling the gaps with the services we do here,” said Davis, “Because the population we serve in dental isn’t the same population for the medical side.”

Behavioral health, general health care, and oral health care are often siloed, which exacerbates barriers that many face to accessing the care they need.

“We emphasize your whole health here and we want to make sure that all of you is doing well”, Davis said.



Addressing Oral Health disparities in North Carolina is tied with improving the overall health and well-being of its citizens. Combining medical, dental, and behavioral health services has become increasingly important in this process. Collectively, these related health fields strive to better the lives of everyone, especially those who have not had the privilege of reliable health insurance and access to care.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!


School-Based Care During a Pandemic

The most important element of childhood development is overall health. With schools nationwide facing unprecedented challenges during the current pandemic, setting children up with proper oral health treatment and education early on can be a determinant of their future success.

Many children, especially in communities that traditionally lack access to care, rely on school to get the oral health treatment they require. This means that during these times, it is more difficult for many children to receive the care they deserve. In a socially distanced interview, we spoke with representatives of Kintegra Health about challenges regarding school-based care during COVID-19.

Dr. William Donigan, general dentist and dental director at Kintegra Health, and Melissa Boughman, dental hygienist and dental ACCESS program director for Kintegra Health, both touched on the importance of providing school-based care to those who do not traditionally have access to oral health care.

Transportation issues are a common theme in Title I schools. Because many parents are not able to regularly bring their children to oral health appointments due to work conflicts or lack of transportation, Kintegra Health’s mobile dentistry units are essential parts of their operation. Operating out of Gastonia, North Carolina, there are two of these mobile units, as well as a dental van for follow-up visits and sealants.

“It’s so wonderful that we’ve been blessed with these mobile dental units that we can drive right up, park, and they bring the children out to us,” Boughman said.

Donigan also emphasized the importance of comprehensive oral care in the areas they serve. “Kintegra has been very responsive to the communities that we are involved in,” Donigan said. “Our mobile dentist unit goes anywhere within thirty minutes of one of our clinics.”

When asked how Kintegra is able to provide patient care during the COVID-19 pandemic, Donigan highlighted the use of intraoral photographs submitted by parents of the children, a supplement to the care provided by the mobile dental units. This increases conservation of personal protective equipment (PPE), lowers chair time, and allows patients to avoid leaving the house altogether for non-emergencies.

However, due to the use of cell phone pictures in these virtual exchanges of information, there have been concerns about image quality.

“The advantage of talking to the parent at that point is we can have them retake and resend the photograph if it’s not good,” Donigan said. “In most instances, we can get a pretty good photograph in those environments.”

Complications in oral hygiene at a young age can extend far into the future. Taking a further look at the world of oral health through the lens of a pandemic provides information about the links between COVID-19 and future health problems in children.

“Just recently, 90 percent of the people on a ventilator with COVID had periodontal disease,” said Donigan. He also mentioned that many diseases, like diabetes and high blood pressure, have relationships with what happens in the mouth. Donigan explained that many of the children Kintegra sees are already prediabetic in elementary school, and good education early in life is vital to helping them begin to lead healthier lives.

“We see the difference in the children we have seen for many years versus the newcomers, like the kindergarteners, and in some schools, pre-k,” said Boughman. “When we see them yearly, we see a big difference. We also provide education because we all know that education is the most important part of all of this. Once we clean their teeth, [plaque and tartar] will come back quickly. But if we teach them how to take care of their teeth, they can have a lifetime of great [oral health].”

Kintegra Health now works with more than 60 schools in seven school systems ranging from Gaston County to Iredell County.

“Today, at Battleground Elementary in Lincoln County, we’ll probably see about 30 children,” Boughman said. Kintegra expects to reach nearly 7,000 children this year, provided that schools are able to maintain traditional classroom meetings.

Kintegra Health staff place an emphasis on creating a relationship with their patients. “We don’t let them fall through the cracks,” Boughman said. “We call them at least three times, and then even send a postcard.” If further dental work is needed, the dental access program assistant will contact parents to explain what was done and make appointments to return if necessary.

Now more than ever, maintaining consistent communication — and being able to provide oral health treatment, when possible — is crucial to school-based care. Kintegra Health’s practice model has become a prime example of how dedicated oral health professionals can overcome the challenges posed by COVID-19.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!